BNF for Children (BNFC) 2018-2019

Calcium chloride 14. 7 % solution for injection 10 ml ampoules|

10 ampouleP£ 77. 95 DT = £ 77. 95

eiiiiF 592

Calcium gluconate

lINDICATIONS AND DOSE

Calcium deficiency|Mild asymptomatic hypocalcaemia

▶BY MOUTH

▶Neonate: 0. 25 mmol/kg 4 times a day, adjusted according

to response.

▶Child 1 month–4 years: 0. 25 mmol/kg 4 times a day,

adjusted according to response

▶Child 5–11 years: 0. 2 mmol/kg 4 times a day, adjusted

according to response

▶Child 12–17 years: 10 mmol 4 times a day, adjusted

according to response

Acute hypocalcaemia, urgent correction|Hyperkalaemia

(prevention of arrhythmias)

▶BY SLOW INTRAVENOUS INJECTION

▶Neonate: 0. 11 mmol/kg for 1 dose, to be given over

5 – 10 minutes, some units use a dose of 0. 46 mmol/kg

( 2 mL/kg calcium gluconate 10 %) for hypocalcaemia in

line with US practice.

▶Child: 0. 11 mmol/kg, to be given over 5 – 10 minutes,

maximum 4. 5 mmol ( 20 mL calcium gluconate 10 %)

Acute hypocalcaemia, maintenance

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Neonate: 0. 5 mmol/kg daily, adjusted according to

response, dose to be given over 24 hours, use oral route

as soon as possible due to risk of extravasation.

▶Child 1 month–1 year: 1 mmol/kg daily, adjusted

according to response, dose to be given over 24 hours,

use oral route as soon as possible due to risk of

extravasation; Usual maximum 8. 8 mmol

▶Child 2–17 years: 8. 8 mmol daily, adjusted according to

response, dose to be given over 24 hours, use oral route

as soon as possible due to risk of extravasation

DOSE EQUIVALENCE AND CONVERSION

▶ 0. 11 mmol/kg is equivalent to 0. 5 mL/kg of calcium

gluconate 10 %.

IMPORTANT SAFETY INFORMATION

The MHRA has advised that repeated or prolonged

administration of calcium gluconate injection packaged

in 10 mL glass containers is contra-indicated in children

under 18 years and in patients with renal impairment

owing to the risk of aluminium accumulation; in these

patients the use of calcium gluconate injection packaged

in plastic containers is recommended.

lINTERACTIONS→Appendix 1 : calcium salts

lSIDE-EFFECTS

GENERAL SIDE-EFFECTSArrhythmias

SPECIFIC SIDE-EFFECTS

▶With intravenous useCirculatory collapse.feeling hot.

hyperhidrosis.hypotension.vasodilation.vomiting

▶With oral useGastrointestinal disorder

lMONITORING REQUIREMENTS

▶With intravenous usePlasma-calcium and ECG monitoring

required for administration by slow intravenous injection

(risk of arrhythmias if given too rapidly).

lDIRECTIONS FOR ADMINISTRATIONForintravenous infusion

dilute to at least 45 micromol/mL with Glucose 5 %or

Sodium Chloride 0. 9 %. Maximum administration rate

45 micromol/kg/hour (or in neonates max.

22 micromol/kg/hour). May be given more concentrated

via a central venous catheter. May be used undiluted ( 10 %

calcium gluconate) in emergencies. Avoid extravasation;

should not be given by intramuscular injection.

Incompatible with sodium bicarbonate and phosphate

solutions.

lPRESCRIBING AND DISPENSING INFORMATIONCalcium

gluconate 1 g contains calcium 89 mg or Ca^2 + 2. 23 mmol.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: tablet, capsule, oral suspension, oral

solution, solution for injection, solution for infusion

Solution for injection

▶Calcium gluconate (Non-proprietary)

Calcium gluconate 100 mg per 1 mlCalcium gluconate 10 %

solution for injection 10 ml ampoules| 10 ampouleP£ 7. 50 –

£ 12. 50 DT = £ 12. 50 | 20 ampouleP£ 30. 00

Effervescent tablet

CAUTIONARY AND ADVISORY LABELS 13

ELECTROLYTES:May contain Sodium

▶Calcium gluconate (Non-proprietary)

Calcium gluconate 1 gramCalcium gluconate 1 g effervescent tablets

| 28 tabletG£ 15. 68 DT = £ 15. 68

eiiiiF 592

Calcium lactate

lINDICATIONS AND DOSE

Calcium deficiency

▶BY MOUTH

▶Neonate: 0. 25 mmol/kg 4 times a day, adjusted according

to response.

▶Child 1 month–4 years: 0. 25 mmol/kg 4 times a day,

adjusted according to response

▶Child 5–11 years: 0. 2 mmol/kg 4 times a day, adjusted

according to response

▶Child 12–17 years: 10 mmol 4 times a day, adjusted

according to response

lINTERACTIONS→Appendix 1 : calcium salts

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Tablet

▶Calcium lactate (Non-proprietary)

Calcium lactate 300 mgCalcium lactate 300 mg tablets|

84 tabletsDT = £ 4. 57 | 84 tabletG£ 4. 57 DT = £ 4. 57

eiiiiF 592

Calcium phosphate

lINDICATIONS AND DOSE

Indications listed in combination monographs (available

in the UK only in combination with other drugs)

▶BY MOUTH

▶Child:Doses listed in combination monographs

lINTERACTIONS→Appendix 1 : calcium salts

lSIDE-EFFECTSEpigastric pain.gastrointestinal disorder.

hypercalciuria

lMEDICINAL FORMS

No licensed medicines listed.

594 Fluid and electrolyte imbalances BNFC 2018 – 2019

Blood and nutrition

9